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International Journal of
Environmental Research
and Public Health
Article
Robotics Utilization for Healthcare Digitization inGlobal COVID-19 Management
Zeashan Hameed Khan 1,* , Afifa Siddique 2 and Chang Won Lee 3
1 Department of Mechatronics and Biomedical Engineering, Air University, Islamabad 44000, Pakistan2 Pakistan Institute of Medical Sciences (PIMS), Islamabad 44000, Pakistan; [email protected] Healthcare MBA Track & School of Business, Hanyang University, Seoul 04763, Korea; [email protected]* Correspondence: [email protected]; Tel.: +923435832018
Received: 16 April 2020; Accepted: 23 May 2020; Published: 28 May 2020�����������������
Abstract: This paper describes the evolving role of robotics in healthcare and allied areas with specialconcerns relating to the management and control of the spread of the novel coronavirus disease2019 (COVID-19). The prime utilization of such robots is to minimize person-to-person contact andto ensure cleaning, sterilization and support in hospitals and similar facilities such as quarantine.This will result in minimizing the life threat to medical staff and doctors taking an active role in themanagement of theCOVID-19 pandemic. The intention of the present research is to highlight theimportance of medical robotics in general and then to connect its utilization with the perspectiveof COVID-19 management so that the hospital management can direct themselves to maximize theuse of medical robots for various medical procedures. This is despite the popularity of telemedicine,which is also effective in similar situations. In essence, the recent achievement of the Korean andChinese health sectors in obtaining active control of the COVID-19 pandemic was not possible withoutthe use of state of the art medical technology.
Keywords: medical robots; COVID-19; healthcare digitization; coronavirus pandemic
1. Introduction
The World Health Organization (WHO) on January 30, 2020 publicly declared the COVID-19pandemic as a “global emergency” because of the rapidity at which it had spread worldwide [1].The virus has shaken worldwide economies leading to a stock market crash in many countries. Since,the first bunch of cases identified in Wuhan City, China, in December 2019, the coronavirus pandemichas rapidly spread across China as well as over the borders, causing multiple incidents in nearly allcountries of the world except Antarctica as shown in Figure 1.
Despite the scarcity of publicly available data, scientists around the world have made progress inestimating the scale of the pandemic, the progression rate, and various transmission patterns of thedisease [2]. Recently, clinical data confirmed that a significant portion of the COVID-19 patients showdiminutive symptoms for the first four days, which illustrates the stealthy transmission potential ofthis contagious disease. Scientists have deliberated that COVID-19 is far more transmittable and lethalthan the ordinary flu [3].
Int. J. Environ. Res. Public Health 2020, 17, 3819; doi:10.3390/ijerph17113819 www.mdpi.com/journal/ijerph
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Figure 1. Total worldwide deaths due to COVID-19 per million people (as on May 27, 2020) [4].
According to the WHO’s situational report 127 published on May 26, 2020, so far, 5,404,512confirmed cases have been reported worldwide with 343,514 casualties [5]. The death rate is highestamong older people compared to young ones, while male patients are more susceptible to risk comparedto female patients in the same age group.
Patients with pre-existing cardiovascular diseases/hypertension, diabetes, cancer, and chronicrespiratory disease have greater probability to pass away due to covid-19 complications comparedto patients without comorbid conditions [4]. United States, China, Italy, Iran, Brazil, France, U.K,and Germany are so far the most affected countries of the world as shown in Figure 2. The routes ofCOVID-19 transmission can be pre-symptomatic, symptomatic or asymptomatic due to the highlycontagious nature of the disease. Therefore, it is of utmost importance to use hand sanitizers, facemasks,and practice social distancing to avoid the viral infection, which can spread through sneezing, touching,and shaking hands. For the medical and healthcare community, the use of personal protectiveequipment (PPE) including N-95 facemasks and gloves for covering against the spread of corona-virusis mandatory for close monitoring of COVID-19 patients. Therefore, alternate technologies involvingmedical robots and tele-medicine systems are in focus in order to control the spread of infection to alarge population [6].
Figure 2. Total confirmed deaths due to COVID-19 on log scale (as on 27 May 2020) [4].
Considering the current disastrous situation, robots are well suited for caring for the well-being ofCOVID-19 patients thus replacing or at least sharing the workload of the medical staff in hospitals
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under oversaturated conditions. A number of robotic systems are used for medical support in hospitalstoday [7]. In China, robots have been assigned multiple tasks to minimize the spread of COVID-19,such as utilizing them for cleaning and food preparation jobs in infected areas hazardous for humans.This study is one of the first studies, which highlights the importance of robotics in hospital andhealthcare facilities specially concerned with the COVID-19 outbreak.
The purpose of this study is to explore strategic healthcare digitization innovation throughrobotics utilization in terms of global COVID-19 management perspectives. This study will providedecision-makers and policy-makers with strategic insights in improving the healthcare quality in localand global disasters together with pandemic settings and other similar situations.
This paper is organized as follows: Section 2 describes the key requirements of robots in thehealthcare sector followed by the application-wise classification of robots in medicine and allied fieldsin Section 3. The viewpoint on COVID-19 management of incorporating robots is discussed in Section 4.Finally, the paper is concluded in Section 5.
2. Requirements of Robots in Healthcare
The applications of robotics and automation in healthcare and allied areas is increasing day byday [8,9]. The International Federation of Robots (IFR) predicts an ever-increasing trend in the demandof medical robots within the coming years with an estimation of 9.1 billion USD market by 2022 asshown in Figure 3. Robots not only help physicians and medical staff to carry out complex and precisetasks but also lower their workload thus improving the efficiency of the overall healthcare facilities [10].
Figure 3. Increasing demand for medical robots in the world market [11].
2.1. Kinematics and Dynamics
The requirement of kinematics and dynamics of a medical robot are application dependent. Serial aswell as parallel robots are used in various tasks ranging from surgical and rehabilitation to servicerobots [12,13]. One such example of Parallel Kinematic Manipulators (PKM) is FlexPicker (ABB, Zurich,Switzerland) also known as “Delta” robot initially designed for surgical applications but also used in thefood manufacturing industry extensively today [14]. Most of the service robots in hospitals are variants ofmobile robots with a high payload capacity but with limited degrees of freedom (DOF). However, surgicalrobots with multi DOF are flexible, precise, and reliable systems offering similar performance to that of awell-trained human surgeon with a minimum error margin typically within millimeters [15,16].
2.2. Control and Dexterity
In order to carryout diverse tasks with high precision, reliability, and repeatability while minimizingthe effects of external disturbances, the control of medical robotics is a challenging issue [17]. Moreover,while addressing the challenge of control and dexterity, designers need to allow sufficient degreesof freedom (DOF) for the end-effector to move in all the desired axes. Medical robots utilizestate-of-the-art technology to carry out various tasks required for cleaning, sterilization, transporting,
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nursing, rehabilitation, and surgical applications. Adaptive robust embedded controllers are generallyimplemented for the control and navigation of such complex and agile robots [18].
2.3. Sterilization
Robots designed for use in healthcare and medicine have stringent cleaning requirements as theymust be free of germs and microbes which can spread communicable and contagious diseases to otherpatients [19]. Most of the surgical end effectors are designed for single use only [16]. Service robotsmust be sterilized from time to time so that they do not become infective carriers [20]. Cooking robotshave their separate protocol for cleaning, as they are washable after use.
2.4. Operator Safety
This is one of the prime requirement in medical robotics as the operator’s safety is very importantwhile handling a robot in the hospital premises [21]. It should be safe enough for the operator,medical staff, and physician/surgeon as well as for the patient to have a robot in close proximitywithin the hospital without posing a threat to anybody. Surgical robots are required to meet the safetyrequirements as directed under standard IEC 80601-2-77 [22]. For rehabilitation robots, the basic safetyand essential performance criteria is provided under standard IEC 80601-2-78.
2.5. Ease of Handling and Maintenance
Robots in hospitals are designed to be operated by medical technicians, medical doctors, and staff
without engineering knowledge and troubleshooting skills. Therefore, the designers always needto ensure simple architecture, easy handling and quick maintenance for long-term usage of suchmachines [23]. Medical service robots help patients with prostheses, orthoses, hearing aids, and visualprostheses and thus require easy maintenance procedures [24].
2.6. Power Requirements
In order to operate medical robots, AC/DC power must be available without interruption so thatthese critical systems can work continuously. Since, medical facilities vary from large scale centrallylocated city hospitals to purpose-built field hospitals, various renewable energy sources are also utilizedfor reliable power solutions [25]. Wireless power transfer is also under development for mobile robotsin hospitals to minimize the need for frequent charging [26].
2.7. Cost
Since, healthcare robotic solutions are needed at a large scale, they must be cost effective for easyinstallation and wide spread availability throughout the world, including developing nations [27].High cost means that the scalability of these systems may not be feasible in most parts of the world.Surgical robotic systems are however, quite expensive solutions as they offer cutting edge technologieswith integrated high definition video systems for tool guidance and maneuvering by the surgeon [28].
3. Classification of Robot Utilization in Healthcare
Robots are mainly classified with various applications in healthcare and related fields.These classifications are broadly designated such as receptionist robot area, nurse robots in hospitalarea, ambulance robot area, telemedicine robot area, hospital serving robot area, cleaning robot area,spraying/disinfestation robot area, surgical robot area, radiologist robot area, rehabilitation robot area,food robot area, and outdoor delivery robot area.
3.1. Receptionist Robots
These types of robots are preferably used at a hospital’s reception to disseminate informationabout various units/sections of the hospital and guide patients and visitors as shown in Figure 4.
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They can handle a number of visitors without becoming tired and direct them to the physician of theirchoice [31]. They also are attractive to children coming to the hospital and amaze them by inducingpleasurable experiences and hence reducing their malaise symptoms.
Figure 4. Receptionist robots in hospitals for patient assistance. (a) Pepper robot in a Belgianhospital [29]. (b) Dinsow 4 robot [30].
3.2. Nurse Robots in Hospitals
These robots are meant to assist doctors in the hospital in the same manner as that of humannurses. Nurse robots are commonly used in Japanese hospitals as Japan has the highest percentageof elderly (above 75 years) individuals among OCED countries. This poses a growing challenge forthe medical facilities in the country. Without sufficient recruitment for elderly care, more Japanesecitizens are socially bound in taking care of aging family members at home instead of doing a job [32].In addition, the nursing and healthcare individuals undergo high stress and exhaustion due to patientload. Therefore, the Japanese government is looking towards technological solutions to take care ofaged patients in the country as seen in Figure 5.
Figure 5. Nursing robots in hospital and at home for elderly care. (a) Robear—a robotic bear nurse to
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lift patients in Japan [33]. (b) Dinsow robot for elderly entertainment and face-to-face calls [34].(c) Moxi—Nursing robot placing medicines in bins [35]. (d) Robot attendant for hospital care [36].
Humanoid nursing robots (HNRs) are likely to replace future nurses in Japanese healthcarefacilities. Robots in nursing are becoming popular in offering services 24/24 and 7/7 with minimalcosts [37]. In Japan, several nurse robots e.g., Paro (AIST, Toyama, Japan), Pepper (Softbank Robotics,Paris, France), and Dinsow (CT Asia Robotics, Bangkok, Thailand) are being used to assist elderlypatients providing lifting as well as in therapeutic assistance. Each one of these robot plays a vital rolein the Japanese healthcare system [38]. As an example, Dinsow has special features for Alzheimer’spatients. For example, it displays pictures of different people and asks the patient to match the facewith a name to improve “dementia” symptoms [34]. However, the acceptance of service robots differsfrom country to country. Moreover, even if HNRs have values, some elderly patients have expressedthe thought that human (staff) presence is also valuable as the machines are not able to replace humansentirely in the healthcare system. Table 1 presents a list of medical robots with applications.
Table 1. List of prominent medical robots with application.
Robot Make Cleaning Nursing Pharmacy Lab FoodService
WasteRemoval Linen
DinsowCT AsiaRobotics
(Thailand)X
Relay Swisslog(Switzerland) X X X X X
TUG Aethon (USA) X X X X X X
RP-VITA iRobot (USA) X
Roombai7 iRobot (USA) X
Moxi Diligent Robots(USA) X X
Ambubot Thailand X X
DroneRobot
TU Delft(Netherlands) X X
3.3. Ambulance Robots
As per statistics, around 800,000 people per year suffer from cardiac arrest in the European Union(EU), out of which only 8% survive this emergency [39]. The main cause of this large number of victimsis due to the comparatively sluggish response time of emergency services (typically 10 min) whereasbrainstem death commences in just 4–6 min after severe cardiac arrest [40].
The immediate medical aid after an accident is critical in order to prevent intensification of trauma.Thus, by speeding up emergency response, more lives can be saved as a result of fast recovery [41].This is particularly factual for drowning, cardiac failure, shocks, and respiratory problems. Lifesavingstrategies such as emergency medication, Cardiopulmonary Resuscitation (CPR), and AutomatedExternal Defibrillator (AED) aids can be designed lightweight and compact enough to be transportedby a flying drone to the emergency site [39]. Such robots are useful in providing emergency treatmentwith minimum response time to a mobile or a distant patient as shown in Figure 6a,b. A lightweightminiature payload is developed for the Ambulance Drone (TU Delft, Netherlands), containing essentialmedical supplies for life support. The early prototype is meant to deliver an Automated Defibrillator(AED) as shown in Figure 6c [40].
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Figure 6. Ambulance robots. (a) Ambubot [39]. (b) Automated External Defibrillator (AED) for patientrecovery [40]. (c) Drone carrying a first aid kit (blue) controlled by a smart phone [41].
3.4. Telemedicine Robots
Such robots are helpful in telemedicine applications where a remote doctor takes all thephysiological parameters and diagnoses a disease using audiovisual aids [42]. Such systems are veryhelpful in the case of large-scale infectious epidemics in remote areas where hospitals and medical staff
are not readily available.Figure 7a shows RP-VITA (MedTech Boston, MA, USA), which is the first FDA-approved
autonomous telemedicine robot. A doctor in a remote location can address the patients using real timeaudiovisual tele-conferencing as shown in Figure 7b. A telemedicine robot in Figure 7c is used forlow-cost remote interface with the patients for diagnosis of ailments.
Figure 7. Telemedicine Robots for real-time remote patient assistance. (a) RP-VITA: FDA approvedfirst autonomous telemedicine robot [43]. (b) Dr. Paul Casey, taking video calls at Rush UniversityMedical Center [44]. (c) Doctor Robot for telemedicine [45].
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3.5. Serving Robots in Hospital
There are many tasks in hospitals where pushing and pulling of material is required.These heavy-duty tasks can be easily carried out by using serving robots [46]. Robots are alsodeployed to supply food to various patients residing in hospital [47]. They are used in the deliveryof food and beverages, dispensing of drugs, removing of unclean laundry, delivery of fresh bedlinen, and transportation of regular and contaminated waste etc. inside the hospital as shown inFigure 8 below.
Figure 8. Indoor serving robots in hospitals. (a) Chinese hospitals using robots to deliver medicines ina patient’s room [48]. (b) Panasonic Autonomous Delivery Robots—HOSPI—deployed in a hospitalin Singapore [49]. (c) TUG autonomous service robot [50]. (d) RELAY robot to deliver medicine [51].(e) LoRobot L1 [52].
3.6. Cleaning Robots
Robots are used in hospital cleaning using dry vacuum and/or mopping [53]. Cleaning robots forhospital environments seem to be able to provide the innovation, which the designers of non-industrialrobot systems anticipated long ago. Such robots are an integral part of disinfecting hospitals to removegerms and pesticides.
Many such systems are depicted in Figure 9. Roomba cleaning robot (iRobot, Bedford, MA, USA)is an intelligent navigating vacuum pump for dry/wet mopping as shown in Figure 9a. UVD robot(UVD Robots ApS, Odense, Denmark) is a ultra-violet radiation based device used to disinfect hospitalpremises from microbes as presented in Figure 9b. Peanut robot (San Francisco, USA) in Figure 9c isused to clean washrooms of hospitals by using a highly dynamic robotic gripper and sensing system.Swingobot 2000 (TASKI, South Carolina, USA) is a heavy-duty cleaning robot for cleaning hospitalfloors autonomously as shown in Figure 9d.
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Figure 9. Cleaning and mopping robots in hospitals. (a) Roomba i7 cleaning robot [54]. (b) UVD robotfor disinfecting hospital premises [55]. (c) Peanut robot for washroom cleaning [56]. (d) Swingobot2000 cleaning robot [57].
3.7. Spraying/Disinfestation Robots
Such robots are widely used in spraying antiseptic mixtures over large outdoor areas e.g.,residential centers of the city. These robots are remotely controlled to avoid hazardous contact with thedisinfectant spray. Figure 10a,b shows such scenarios where sanitary workers on scooters control therobot in order to disinfect the surroundings.
Figure 10. Spraying and sanitizing robots in residential areas of China [58]. (a) Remote controldisinfecting mobile robot in Hangzhou, China. (b) Spraying robots to disinfect large residential areasin China. (c) A hand sanitizer-dispensing robot in Shanghai.
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Autonomously guided hand sanitizer dispensing robots are designed to alleviate infections onhuman hands and faces. Such alcohol-based sanitizers remove bacteria, viruses, and other microbes toprevent the spread of contagious diseases among large populations as shown in Figure 10c.
3.8. Surgical Robots
Surgical robots offer minimally invasive surgery (MIS) with precision and accuracy compared tohuman surgeons. Many tele-operators have been designed for remote surgeries [59]. The Da Vincirobotic surgical system from Intuitive Surgical Inc.is one such popular example as shown in Figure 11.
Figure 11. Da Vinci robotic surgical system [60]. (a) Patient cart. (b) Surgeon console. (c) Vision cart.
Nowadays, fourth-generation Da Vinci surgical systems (Intuitive Surgical, California, USA) withcomplex machines but simple movements continue to advance MIS across a wide spectrum of surgicaltechniques. This offers upgradable design with flexible configurations and a dependable interfacefor surgeons using Da Vinci systems as shown in Figure 12. Standardization of instruments andcomponents help hospitals to manage inventories and improve efficiency [60].
Figure 12. Real time surgery via HD vision using Da Vinci robotic surgical system [61]. (a) Surgeonremote manipulation. (b) Patient being operated by robotic hands.
Many other types of specialized surgical robots are in use for general endoscopic, cranial andspine surgery as well as for biopsy as shown in Figure 13a,b. Revo-I is termed the Korean version
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of the Da Vinci surgical system. KUKA LBR Med surgical robot (KUKA, Augsburg, Germany) is ahigh-performance serial robot for carrying out complex surgical procedures as shown in Figure 13c.
Figure 13. Specialized robots for general, spine and cranial biopsy and surgery. (a) Revo-i surgicalrobot [62]. (b) STEALTH AUTOGUIDE: Cranial Robotic Guidance Platform [63]. (c) KUKA LBR Medsurgical robot [64].
The LBR Med is a sensitive seven-axis lightweight robot; it is very flexible and easy to integrateinto medical products for numerous surgical interventions. It is perfectly suited to applications inmedical technology due to its responsive sensors, inclusive safety provisions, hygiene-optimizedsurfaces, and a controller intended for direct collaboration with the human operator [64].
3.9. Radiologist Robots
Radiology is one of the key technologies where robots are installed on special demand due to highlevel of radiations and safety issues for human operators. Twin Robotic X-ray (Siemens Healthineers,Henkestr, Germany) by Siemens is an innovation in radiology which offers fluoroscopy, angiography,and 3D imaging as shown in Figure 14a [65]. It performs a multitude of X-rays in just one roomwhere the physician is able to see 3D images in real time as the robot moves instead of the patient.Conventional 2D X-rays usually fail to reveal fine hairline fractures in the bone and therefore require acomputed tomography (CT) 3D image to confirm the diagnosis. With the Multitom Rax Twin RoboticX-ray system, a 3D image can be picked up conveniently on the same system, thus eliminating theneed for a CT system.
Cyberknife precise robotic (Cyberknife Accuracy, Sunnyvale, USA) treatment is used forradiotherapy of cancer patients as shown in Figure 14b. It delivers stereotactic radiosurgery (SRS),and stereotactic body radiation therapy (SBRT), treatments anywhere in the body with high tech roboticprecision and integrated real-time motion synchronization [66].
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Figure 14. Specialized robots for spine and cranial biopsy and surgery. (a) Multitom Rax: Twin RoboticX-ray from Siemens Healthineers [65]. (b) Cyberknife: Radiology Oncology Surgical robot [66].
3.10. Rehabilitation Robots
These robots are helpful in rehabilitation of patients after an accident or stroke [27]. They are helpfulin assisting and treating the disabled, elderly, and inconvenient conditions of people. These robotspromote functional reorganization compensation and regeneration of the nervous system, effectivelyalleviating muscle atrophy [67]. As a result, rehabilitation physicians and staff are relaxed fromoverwhelming physical labor, thus optimizing the healthcare resources. Some examples of assistiveand rehabilitation robots are shown in Figure 15 wherethe Kinova assistive robot (Kinova Robotics,Boisbriand QC, Canada) helps patients to pick and place objects with multi DOF performance andcan be interfaced using brain computer interface (BCI). EksoNR (ekso bionics, Richmond, USA) is anexoskeleton for improved locomotion of disabled people [68].
Figure 15. Rehabilitation and assistive robots. (a) Kinova assistive robotic arm [69]. (b) EksoNRexoskeleton [70].
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3.11. Food Robots
These robots are an integral part of a hospital’s kitchen and pantry in order to deliver high qualityfood as per hygienic standards [8]. From cooking to serving, various different types of automationand robotic systems have been designed by the roboticists. One such robot chef is used in Chinesehospitals as shown in Figure 16a. Serving robots to deliver food in hospital’s restaurants are shown inFigure 16b. Cooki (Sereneti Kitchen , Atlanta, Georgia, USA) and Moley (Moley Robotics, London, UK)are two different types of cooking robots with one and two robotic hands and are shown in Figure 16c,drespectively [71,72].
Figure 16. Food robots in a hospital’s kitchen for preparing and delivery. (a) Robot chef in aChinese hospital [58]. (b) Food delivery robot in hospital [58]. (c) Cooki robot to prepare meals [71].(d) Moley—World’s first robotic kitchen [72].
3.12. Outdoor Delivery Robots
Such robots are useful in transporting/delivering drugs and blood samples to/from the hospital.These fully autonomous robots can operate on the ground or in the air autonomously or withman-in-the-loop operation whereas an operator at a distance can remotely control them. Examplesystems include drone delivery robots by “Flirtey (Flirtey, Reno, Nevada, USA)” which aim to savelives and improve lifestyles by making delivery instant for everyone as shown in Figure 17a [73].
Starship robots (Starship Technologies, San Francisco, USA) are another example of ground baseddelivery robots that can carry less than 100 pound items within a 4-mile (6 km) radius as shownin Figure 17b. Items of interest include medicines, parcels, groceries and food, which are directlydelivered from pharmacies and stores as per the order generated by customer requests via a mobileapp. After placing the order, the robot’s entire journey and location is observed on a smartphone.Furthermore, to ensure secure delivery, an electromechanical lock is used to arm the cargo baythroughout the voyage. It is opened at the recipient end by using the smartphone app [74].
Table 2 presents a list of major medical robots with technical specifications involving theirparticular applications, weight, dimensions, nominal payload, operation duration, maximum speed,and the origin of the manufacturing company.
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Figure 17. Outdoor delivery robots (ground based and aerial systems). (a) Flirtey drone robot fordelivery of medicine/blood sample/food [73]. (b) Starship autonomous delivery robot [74].
Table 2. Comparison of various medical robots and their specifications.
Title Application Weight[kg]
Dimension[m3]
NominalPayload [kg]
Operationduration
[hr]
Max Speed[m/s] Origin Ref
RELAY Service 40.8 0.021 4.5 4 0.7 Swisslog,Switzerland [51]
TUG(T3 XL) Service 635 1.034 - 10 0.76 Aethon, USA [50]
HOSPI Service 170 0.633 20 9 1.0 Panasonic,Singapore [49]
RP-VITA Telemedicine 79.37 0.565 - 4–5 Pan: 90 ◦/sTilt: 60 ◦/s iRobot, USA [43]
Roomba i7 Cleaning 3.37 0.01 0.37 1.25 0.3 IRobot, USA [54]
LG HOM-BOT Cleaning 3.17 0.0086 0.5 1.75 0.35 LG, South Korea [75]
KINOVAGEN3 Assistive 7.2 902 mm
(max reach) 2.0 - 0.5 KINOVA, USA [69]
EksoNR Assistive 25 - 100 1 Variable Ekso Bionics, USA [70]
Mazor X Spine Surgery 6.9 0.012 - - - Medtronic, USA [76]
Swingobot2000 Cleaning 252 1.56 90 4 0.62 Diversey Inc, USA [57]
Cyberknife Radiosurgery 1267 1.01 240 - - Accuracy, USA [66]
LoRobot L1 Service 200 0.84 100 8 1.2 Hills, South Korea [52]
- refers to information not available or not applicable.
4. Viewpoint on COVID-19 Management
As shown in recent reports regarding COVID-19, most fatalities occur in old aged people especiallywith comorbidities as shown in Tables 3 and 4 respectively. For the management of COVID-19 patients,guidelines have been established by centers for disease control and prevention (CDC). These guidelinesare listed as follows [77,78]:
(a) Healthcare facilities should prioritize only urgent and emergency visits to fight against COVID-19.All elective and non-urgent admissions must be rescheduled.
(b) Preserving staff personal protective equipment (PPE) and patient care supplies for the safety ofboth is very important.
(c) Routine dental and eye-care visit must be postponed.(d) All inpatient and outpatient elective surgical and procedural cases must be delayed to give
priority to COVID-19 patients.(e) Old age patients with underlying conditions are more vulnerable compared to young patients.(f) Patients with underlying chronic medical conditions and pregnancy are at high risk due to
this disease.(g) Patients with mild clinical presentation may not initially require hospitalization.(h) However, all patients with worsening signs and symptoms should be monitored closely with
respect to the infection progress to the lower respiratory tract during the second week of illness.
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(i) The decision to monitor a patient in the inpatient or outpatient setting is dependent on theclinical presentation.
(j) The estimated incubation period for COVID-19 is four days (interquartile range: 2–7 days) whilesome studies recommend a wider incubation of 2–14 days based on data from other coronaviruses(e.g., MERS-CoV, SARS-CoV).
Table 3. Age related case fatalities of COVID-19 [79].
Patient Age Case Fatality
30–39 0.2%
40–49 0.4%
50–59 1.3%
60–69 3.6%
70–79 8%
≥80 14.8%
Table 4. Comorbid case fatalities of COVID-19 [79].
Comorbidities Case Fatality
Cardiovascular disease 10.5%
Diabetes 7%
Chronic respiratory failure 6%
Hypertension 6%
Cancer 6%
4.1. Clinical Presentation
COVID-19 patients admitted to hospital have indicated symptoms e.g., fever, cough, shortness ofbreath, and fatigue as shown in Table 5. While fever is the dominating symptom of the patients admitted,other less commonly reported respiratory symptoms include sore throat, headache, cough withsputum etc. Prior to developing fever and lower respiratory tract symptoms, some patients reportedgastrointestinal symptoms as well.
Table 5. COVID-19 patient’s reported symptoms [77].
Symptoms Percentage
Fever 77–98%
Cough 46–82%
Myalgia or fatigue 11–52%
shortness of breath 3–31%
4.2. Diagnostic Testing
Specimens collected from the nose of patients are analyzed in labs for possible detection ofCOVID-19. Nasopharyngeal (NP) specimen is preferred for the detection of upper respiratory tractinfection. Specimen from the lower respiratory tract including lung biopsy can also be helpful forpatients presented with more severe disease. Serum analysis is helpful in monitoring antigens/antibodiescount in COVID-19 patients. CT images of the chest have shown bilateral involvement in mostpatients [76].
Since, there is no currently available treatment for COVID-19, recommended infection preventionand control measures and supportive management of complications is the only possible clinical
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management. In some cases advanced organ support may be recommended as per need [78].Few antiviral drugs e.g., Remdesivir and chloroquine have been shown to be affective againstSARS-CoV-2 [80,81]. Moreover, many efforts are underway to produce a vaccine for COVID-19 virus.Patients affected by COVID-19 virus are required to isolate in hospitals or at home for two weeks.
4.3. Case Study—COVID-19 Wuhan, China
The Chinese health ministry actively pursued the management of COVID-19 to avoid the blowoutof the disease. In this pursuit, various robotic technologies were used to control and administer thisepidemic as shown in Figures 18 and 19.
Figure 18. Robots in action during the COVID-19 epidemic in China [82]. (a) A patrol robot at ahospital in Shenyang in China’s northeastern Liaoning province checking temperatures of people.(b) Technicians adjusting disinfection robots in a technological company in Qingdao, east China’sShandong Province.
Figure 19. Reception robots in China during the COVID-19 outbreak. (a) Sterilization robot in Wuhan,China [83]. (b) Reception robot at a hospital ward in Wuhan, China [84].
From service robots to disinfectant robots, hospitals frequently utilized technology to deal witha wide number of infected patients. Based on the technology-based solutions, very few cases werereported where infection was transmitted to the healthcare professionals. In China, such robots areeffective in receiving the patients at the reception desk and monitoring their initial symptoms (such asflu and fever) and to disinfect them right at the entry point during the COVID-19 epidemic period.CloudMinds (USA) donated 5G Cloud Robots to various hospitals in Wuhan and Shanghai to help theChinese healthcare community to fight against the coronavirus as shown in Figure 20.
It has been observed from expert reviews that the Chinese and Korean governments’ promptreply in addressing the epidemic of COVID-19 was a successful attempt by using advanced measuresand technology to manage the situation. These guidelines have been open for the world to take thesame measures in order to stop COVID-19 fatalities. As seen from the data presented in Tables 3 and 4most of the serious cases arise in aged patients with comorbid conditions. For such patients, nursing
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and telemedicine robots are preferred. Moreover, in order to keep the environment clean, robots canhelp in disinfecting and sterilizing hospital premises and residential areas. A detailed mapping ofthese robotic technologies for COVID-19 management is depicted in Table 6.
Figure 20. 5G Cloud robots deployed in Chinese hospitals [85].
Table 6. Mapping of COVID-19 management steps using robotic solutions.
COVID-19 EDCRecommendation Category Prevention Robotics Solution
Initial contact andassessment
Primary andemergency care
PPE, N95 face mask, goggles,gloves etc.
Robot doctor, Robot nurse,Ambulance robot
Hand hygiene Personal hygiene Sterilization Sanitizer dispensing robot
Surface decontamination Environmental hygiene Use of hypochlorite or alcohol baseddisinfectants e.g., ethanol
Spraying robot for outdoor and UVrobots for indoor disinfection
Patient Transport Ambulance transferSurgical mask for the driver, PPE for
the accompanyinghealthcare worker
Self-driving car (SDC) to carry patients
Hospital
Administration measures PPE, N95 face mask, goggles,gloves etc. Robot receptionist
Patient management as above Tele-medicine Robot, lifting robot toshift patients from one place to another
Pharmacy as above Medicine dispensing robot,drone robots
Food services as above Robot chef, Food delivery robot
House keeping as above Autonomous service robots
Environmental Cleaning& waste management as above Cleaning/disinfection robots
Lab testing/Imaging Blood test/samplecollection/X-ray as above
Sampling robot, Biopsy using surgicalrobot, SDC for sample collection, 3D
X-ray and U/S robot
Management ofthe deceased Administration measures as above Nursing robot for lifting, SDC for
transportation to cemetery
Long term care facilities Palliative Care as aboveEntertainment robots, tele-medicine
robot, Nursing robot, Rehabilitation andAssistive robots
5. Conclusions
This study presents a comprehensive overview of the robotics potential in medicine and alliedareas with special relation to the control of the COVID-19 pandemic. Effective management ofCOVID-19 can significantly reduce the number of infected patients and casualties as witnessed in thecase of the Chinese outbreak. Since, it has currently turned out to be a global challenge, technologicallyadvanced countries can aid others by donating support equipment and robotic infrastructure to enablea good outcome in controlling this disease. This review substantiates that the introduction of medicalrobotics has significantly augmented the safety and quality of health management systems comparedto manual systems due to healthcare digitization. Classification of medical robots is only done usingapplication based categories to fit every aspect of hospital services ranging from cleaning robots to
Int. J. Environ. Res. Public Health 2020, 17, 3819 18 of 21
highly sophisticated surgical robots. Many opportunities are available in the design and operation ofmedical robots such as a cyber-physical system (CPS), power management using optimized algorithmsand renewable sources, as well as fault tolerant control and dependable architectures for reliable andsafe operation within the healthcare facilities.
Author Contributions: Conceptualization, Z.H.K.; methodology, A.S.; validation, C.W.L.; formal analysis, Z.H.K.;investigation, A.S.; resources, C.W.L.; writing—Original draft preparation, Z.H.K.; writing—Review and editing,Z.H.K. and C.W.L.; project administration, Z.H.K.; funding acquisition, C.W.L. All authors have read and agreedto the published version of the manuscript.
Funding: This research received no external funding.
Conflicts of Interest: The authors declare no conflict of interest.
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